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BDSM Checklist

Please note that this checklist is not intended to replace negotiations or future planning; rather enhance it by allowing both parties to give/gain some basic information prior to further discussion. Please feel free to print and amend as necessary and bring it along to your next session. You may N/A in any areas.

First Name

Last Name

Email

Phone

Which D/s Experience would you like to book?

Two Doms, One Sub

BDSM Traditional Session

Fetish Specific Session

Corporal Punishment/Pain Session

Private Lesson for Couples

BDSM/Kink Photo Shoot

Vanilla Sky Photo Shoot

List any specific fetishes you have:

Do you have or ever had any known STD's? If yes, disclose

My experience level is:

Beginner

Average

Extensive

Settings you are comfortable playing in:

1 on 1

Public play

Male and Female Dom/me

Multi-Domme

Scenes with 2-6 players

Other

I have medical conditions or limitations my partner should know about. For example: allergies, asthma, breathing problems, high blood pressure, seizures, heart condition, circulation, etc.

List any known allergies. For example: latex, food, scents, oils, lotions, etc.

Do you have any phobias or fears your partner should know about? Example: blood, needles, enclosed areas, etc.

Physical aspect of desire:

A feeling of confinement

A feeling of helplessness

A feeling of pressure

A feeling of Safety and Security

A feeling of sensuality

A feeling of dominance

A feeling of comfort

What is your main interest?

Sensual and Physical

Mental

Both equally

What do you get out of a session?

A sexual thrill

Adrenalin rush

Calmness

Relief from the pressures of the world

Sanctuary

It's theraputic

You level of interest in bondage?

Total helplessness

Light bondage

Not my favorite, but I'll do it

Relief from the pressures of the world

It is a hard limit

Never tried it

Pain: What are you, or what are you lookng for?

I'm a pain slut

I want whipping, caning, paddling

I want sensual whipping, light paddling, and NO marks on my body

I want punishment, but only when necessary

I'm interested, but never tried it

Pain is a hard limit for me

In a scene, I prefer to wear:

Nothing

Lightly clothed

Leather

Latex/Rubber

Lingerie

I don't care

In your opinion, what is the purpose of pain?

Pain is a punishment

Pain is a reward

Pain coinsides with pleasure

Pain is for training, or correction only

Whatever pleases my partner

Pain is a hard limit

Abduction Fantasy

Yes

No

Beating: by hand or prop

Yes

No

Blindfolds

Yes

No

Bondage

Yes

No

Breast Bondage

Yes

No

Breath Play

Yes

No

Candle Waxing

Yes

No

Caning

Yes

No

CBT: female domme/male submissive only

Yes

No

Chastity Belt

Yes

No

Choking

Yes

No

Cigarette/Cigar Play

Yes

No

Clothespins

Yes

No

Collars

Yes

No

Electric Play

Yes

No

Examination: physical or visual

Yes

No

Face Slapping

Yes

No

Flogging

Yes

No

Foot Fetish

Yes

No

Forced Nudity: you will be restrained and stripped, or instructed to strip

Yes

No

Forced Orgasms

Yes

No

Full Head Hood

Yes

No

Gags

Yes

No

Hair Pulling

Yes

No

Handcuffs

Yes

No

Humiliation: verbal, private, public

Yes

No

Ice Play

Yes

No

Interrogation

Yes

No

Knife Play

Yes

No

Medical Play

Yes

No

Metal: restraints, gags

Yes

No

Nipple Clamps

Yes

No

Role Play

Yes

No

Rope

Yes

No

Rope Suspension

Yes

No

Spanking

Yes

No

Water Boarding

Yes

No

Water Bondage

Yes

No

Whipping

Yes

No

Your Signature

Upload File

Driver's License or Valid ID

Thanks for your submission!

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